Individual
MRS. TIJUANA THERESA LANE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
535 CINNAMINSON AVE, PALMYRA, NJ 08065-1610
(856) 287-3578
Mailing address
3 VASSAR RD, MOUNT LAUREL, NJ 08054-5236
(856) 287-3578
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
ZVAVGK6TPE
NJ
335E00000X
Prosthetic/Orthotic Supplier
—
NJ
Other
Enumeration date
10/02/2023
Last updated
08/21/2024
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